Are State Doctors in the Western Cape willing to implement the Choice of Termination of Pregnancy Act of 1996?

An opinion survey conducted in the Western Cape in November 1997. In fulfillment for the requirements of the FCOG (S.A.) part 2.

Questionnaire

Reproduced with permission

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17.11.97

Dear Doctor,

Re: Survey of doctors attitudes towards the implementation of the choice of Termination of Pregnancy Act 1996.(Cape Province only)

Shortly, you will be receiving a number of questionnaires each separate in its A4 size envelope containing:

1. a questionnaire

2. a covering letter explaining the survey.

3. a self addressed envelope.

Would you kindly distribute one envelope to every doctor in your institution who in the normal course of his or her duty would be responsible for seeing/ evaluating or managing abortion clients?

· Please inform each doctor that the return envelope does NOT require a stamp.

· Please encourage full participation. If the number of returned questionnaires is too small then no scientific conclusion can be drawn from this study.

· A second survey will not be logistically or statistically feasible.

· We are relying on your generous cooperation.

The material should arrive within 2 weeks. If staff are on leave, kindly ensure that each member will get one, (and no more than one), envelope on return.

Thank you for your cooperation,

Dr.Harvey R.G.Ward
Clinical Assistant, Obstetrics and Gynaecology
Tygerberg Hospital

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Department of Obstetrics and Gynaecology,
Tygerberg Hospital,
Bellville 7505.

Dear Colleague,

Study on Doctor's attitudes to the Choice of Termination of Pregnancy Act 1996.

1.Since the Choice of Termination of Pregnancy Act of 1996 was implemented on February 1^st 1997, referral patterns suggest that many institutions designated by the Minister of Health for such purposes do not have doctors willing to provide the service, either totally or selectively according to their own convictions.

2.This survey is designed to determine to what extent objections to the implementation of the Act exist among the doctors currently expected by the Department of Health to offer this service in Cape Provincial institutions.

3.You can be assured that the information gathered in this survey will guarantee the anonymity of both yourself and your institution.

4.In order to obtain as complete a response as possible, this survey may have 2 consecutive mailings. Each approximately 3 3 weeks apart. If you have already filled in a form and posted it, kindly ignore further mailings. Reminders will be faxed to you. Please do not send more than one. You are kindly requested to carefully fill out this questionnaire and return it (in its addressed envelope) as soon as you can.

5. Please feel free to fill in any comments, in (Afrikaans, English or Xhosa) that you would like to make in the space provided or on the back of your questionnaire.

6. The information gathered will form the basis of a presentation to the SASOG Congress in March 1998 on the State Doctors Attitudes to the implementation of the Choice of TOP Act by Dr.H.R.G.Ward and as part of the panel discussion. Your comments and suggestions may be included in subsequent recommendations to the Department of Health.

Your assistance and cooperation is greatly appreciated.

Dr. Harvey R.G. Ward
Senior Registrar: Obstetrics and Gynaecology

Professor H.J.Odendaal
Head of Department.

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State Doctors' Attitudes to the implementation of the Termination of Pregnancy (TOP) Act of October 1996.

Profile (please CIRCLE your answers clearly)

Specialist	yes | no
Registrar/clinical assistant	yes | no
Medical officer/house officer	yes | no
General practitioner	yes | no
Part-time or Full-time employment with the State?	full | part
Do you hold a district surgeon's post?	yes | no
Years qualified since basic medical degree (MBChB)	<10 | 11to20 | 20to30 | >30
Were you occupying this post on 1 Feb. 1997?	yes | no
Will you be occupying this post after 31 December 1997?	yes | no | maybe
Age	<30 | 31-40 | 41-50 | 50-60 | >60
Gender	male | female
Type of institution (primary=1, secondary=2, tertiary=3)	1 | 2 | 3

TRAINING (formal = structured course)

	formal	informal
Have you had any hands-on training for TOP's?	yes	yes | no
Can you use a Manual vacuum aspirator?	yes	yes | no
Have you performed a paracervical analgesic block?	yes	yes | no
can you perform a cervical dilatation and uterine curettage?	yes	yes | no
Have you been trained to give pre abortion counselling?	yes	yes | no
Have you been trained to give post abortion counselling?	yes	yes | no
Can you manage post abortion complications at your facility?	yes | no
Have you trained any person to perform TOP's since 1 Feb 1997?	0 | <5 | 5 to 10 | >10
Are trainees (to perform TOPs) currently at your institution?	yes | no
If offered a course to train you to perform TOPs, would you attend?	yes | no
Have you attended a Values Clarifications Workshop?	yes | no

CURRENT SITUATION AT YOUR INSTITUTION:

Does your institution provide an abortion service?	full | limited | no
If NOT, are State patient applicants referred:
to the private sector for TOP?	yes | no
to a non governmental organization (i.e. Marie Stopes Clinic)?	yes | no
to another State Hospital?	yes | no
Do you refer applicants to a crisis pregnancy centre?	yes | no
Is there an anaesthetic service for TOP's?	yes | no

IN YOUR OPINION:

Should your institution be offering a TOP service at all?	yes | no | not sure
If NOT, should this be offered at a specified separate venue?	yes | no | not sure
Should separate staff be appointed to provide this service?	yes | no | not sure
Should interviews, procedures and counselling be performed by:
doctors?	yes | no | not sure
trained midwives?	yes | no |not sure
trained paramedical personnel?	yes | no | not sure
If NOT, should the service be offered anywhere at all?	yes | no | not sure

PERSONAL PREPAREDNESS:

In accordance with the Choice of TOP Act of Oct 1996, are you prepared to:

1.interview and examine abortion applicants?	yes | no | not sure
2.interview, examine and counsel abortion applicants?	yes | no | not sure
3.prescribe misoprostol or prostaglandins for abortive purposes?	yes | no | not sure
4.perform cervical dilatation and curettage for TOPs?	yes | no | not sure
5.use a manual vacuum aspirator for TOPs?	yes | no | not sure
6.provide post abortion counselling?	yes | no | not sure

Would you perform abortions up to 20 wks as per the TOP Act for the following cases:

1.lethal congenital abnormalities?	yes | no | not sure
2.nonlethal surgically correctable/medically manageable anomalies?	yes | no | not sure
3.nonlethal uncorrectable abnormalities?	yes | no | not sure
4.in the instance of rape?	yes | no | not sure
5.in the instance of incest?	yes | no | not sure
6.in certified psychiatric women who become pregnant?	yes | no | not sure
7.where ongoing pregnancy may cause maternal death?	yes | no | not sure
8.where ongoing pregnancy may probably cause permanent maternal organ damage?	yes | no | not sure
9.for adverse socio-economic situations?	yes | no | select

If you are not prepared to do any of the above, would you:

refer to another doctor?	yes | no
refer to another midwife?	yes | no
refuse to see these patients at all?	yes | no
continue an abortion (started by someone else) presenting with:
1.threatened abortion?	yes | no
2.Inevitable abortion?	yes | no
3.Incomplete abortion?	yes | no

For inevitable/incomplete abortions would you:

1.admit ,sedate and give analgesia only?	yes | no
2.Admit sedate/give oxytocin, analgesia and proceed with evac?	yes | no

Were you ever consulted before the 1996 TOP Act was passed either personally or by questionnaire to determine your willingness to perform TOPs according to the Act?	yes | no
Were you ever informed personally or by official notification of your rights to refuse to perform or participate in the abortion process unless in the rendering of maternal life saving treatment?	yes | no

Own comments/(English or Afrikaans only please):

Kindly send your completed form in the self addressed envelope as soon as possible.